Urban Residents Research Articles

Escalation to Biologics After Methotrexate Among US Veterans with Rheumatoid Arthritis Grouped by Rural Versus Urban Areas.

Racial and ethnic disparities in rheumatoid arthritis (RA) outcomes are well recognized. However, whether disparities in RA treatment selection and outcomes differ by urban versus rural residence, independent of race, have not been studied. Our objective was to evaluate whether biologic disease modifying anti-rheumatic drugs (bDMARD) initiation after methotrexate use differs by rural versus urban residence among Veterans with RA. In this retrospective cohort study utilizing national U.S. Veterans Affairs databases, we identified adult patients with RA based on presence of diagnostic codes and DMARD use. We included patients receiving an initial prescription of methotrexate (index date) between 2005 and 2014, with data through 2016 used for follow-up. Urban-rural status was categorized using the Veteran Health Administration's Urban/Rural classification. Our primary outcome of interest was time to biologic initiation within two years of starting methotrexate. Multivariable Cox proportional hazards models were conducted adjusting for demographics, comorbidities, and rheumatoid factor or anti-CCP positivity. Among 17,395 veterans with RA (88% male, 42% with rural residence) fulfilling eligibility criteria, 3,259 (19%) initiated a biologic within the first two years of follow up. In multivariable models, residence in an urban area was associated with a statistically significant higher biologic use compared to rural areas (adjusted hazard ratio (aHR) 1.10, 95% CI 1.02-1.18). Our study found only modest differences in initiation of biologic therapies among rural versus urban residing Veterans with RA in the VA healthcare system. These findings suggest that disparities are not easily explained by rurality within the VA healthcare system.

The association between health literacy and colorectal cancer screening uptake in Taiwan

Abstract Background Population-based cancer screening programs have been confirmed as a cost-effective strategy for early detection of colorectal cancer, leading to reduced mortality and morbidity. In Taiwan, the government has provided an immunochemical fecal occult blood test (iFOBT) every two years to all citizens aged 50 to 74 years since 2013. The study aims to determine the association between iFOBT uptake and health literacy (HL). Methods Data from the National Health Interview Survey (NHIS), a population-based cross-sectional survey conducted in 2021-22 in Taiwan, were applied. The European Health Literacy Survey Short Form (HLS-EU-Q16), self-reported iFOBT participation within the past 2 years, and covariates assessed by face-to-face interview. The present analysis included those age-eligible for screening (n = 3,871) and applied the survey-weighted multivariable logistic regression to estimate odds of iFOBT uptake between HL skill levels, controlling for age, education attainment, socioeconomic status, health status, and household urbanicity level. Results In general, 44.6% of participants had utilized the iFOBT, and 79.9% had adequate HL skills which reported higher iFOBT uptake rates (45.9%) than their counterparts (39.4%). Multivariable analysis showed that having adequate HL was associated with greater odds of iFOBT utilization (adjusted odds ratio [aOR] = 1.79; 95% CI: 1.29-2.49). Additionally, compared to those households registered in the township, participants in higher urbanicity levels had lower iFOBT uptake: city (aOR = 0.62; 95% CI: 0.47-0.82). Other predictors that contributed significantly were participants’ gender and having 2 or more chronic diseases. Conclusions Inadequate HL skills and urban residency may reduce participation in the CRC screening program, despite its free availability. More efforts should include literacy-friendly designed materials and the provision of tailored support in urban settings. Key messages • HL skills are significantly associated with the CRC screening uptake in Taiwan. Improving HL could have positive effects on people’s participation. • Urbanicity levels are also predictors associated with screening utilization. Disseminating health service information in localized ways should be a potential option.

Exploring the association between cyberchondria and attention to negative information

Abstract Objectives This study aimed to preliminarily evaluate the relationship between cyberchondria and attention to negative information. Methods The data utilized for this analysis was obtained from a cross-sectional and web-based survey conducted in China between March and April, 2024. All participants were recruited from an online panel belonging to a survey company. Cyberchondria was assessed using the Chinese version of the Cyberchondria Severity Scale - 12 item (CSS-12). Attention to negative information was measured using the negative subscale of the Attention to Positive and Negative Information Scale (APNIS). A multivariable linear regression model was employed to evaluate the relationship between cyberchondria and attention to negative information. Results Out of 344 participants, 315 (91.6% response rate) completed the questionnaire and provided valid responses. Approximately 51.7% (n = 163) were female, 83.8% (n = 264) had completed tertiary or higher education, and 52.7% (n = 166) were urban residents. The average age was 32.6 years (SD = 6.0). The mean score for CSS-12 was 40.6 (SD = 7.8, range: 18-59). The mean scores for the different dimensions of the CSS-12 were: excessiveness, 10.6 (SD = 2.4); distress, 10.3 (SD = 2.7); reassurance, 10.6 (SD = 2.5); and compulsion, 9.1 (SD = 2.7). The mean score for the negative subscale of APNIS was 31.9 (SD = 8.6, range = 12-52). Multivariable linear regression models revealed a statistically significant relationship between cyberchondria and attention to negative information (beta = 0.42, p < 0.001), after adjusting for background characteristics. Conclusions Our findings showed individuals with a higher level of cyberchondria tend to pay more attention to negative information. Therefore, it’s beneficial to develop strategies and interventions that provide accurate, balanced online health information and educate individuals about the risks of excessive online health searches. Key messages • Our findings showed individuals with a higher level of cyberchondria tend to pay more attention to negative information. • It is beneficial to develop strategies and interventions that provide accurate, balanced online health information.

Prevalence and social determinants of anxiety and depression among adults in Ghana systematic review

Abstract Background Anxiety and depression are major public health concerns, yet their prevalence and social determinants contributing to mental health disparities remain underexplored. This review, to our knowledge, is the first of its kind, aiming to examine the prevalence of anxiety and depression symptoms and disorders among adults in Ghana, along with social determinants associated with their occurrence. Methods A search of nine electronic databases and seven grey literature sources was conducted up to September 25, 2023. Two reviewers independently screened and appraised the studies. Forty-six studies were included. Prevalence estimates were pooled using a random-effects model. Subgroup analysis and meta-regression explored potential moderators. A narrative synthesis explored social determinants associated with anxiety and depression. Results Preliminary results showed a high prevalence of anxiety (43.7%, 95% CI: 35.6-54.4%) and depression (37.8%, 95% CI; 32.5% to 46%), with regional variations. There were significant differences in the prevalence of anxiety and depression across chronic physical conditions and method of condition assessment. Meta-regression showed significant association between average age and anxiety prevalence. Social determinants associated with anxiety included being female, non-Christian, low income, self-employed, limited social support, and basic education, while that for depression included being young (< 25yr), low income, government employed, childhood physical and sexual abuse, gender-based violence and urban residence. Protective factors for both were male gender, strong social support and higher education. Conclusions Preliminary results indicate a high prevalence of anxiety and depression linked to social determinants. While methodological limitations exist (eg, study heterogeneity), findings highlight a need for evidence-based interventions targeting social determinants to reduce the burden of anxiety and depression among adults in Ghana. Key messages • Our review suggests addressing the social determinants of mental health, aligned with sustainable developmental goals, may reduce the burden of anxiety and depression. • While Ghana is working towards improving mental health via its revised 12year Mental Health Policy launched in 2021, this review can facilitate planning and resource allocation for mental healthcare.

Long-term disability following childhood injury: an imperative to monitor and address the continuum of trauma care

Abstract Background While injuries remain a leading cause of childhood death, increasing proportions of children survive life-threatening injuries. However, robust epidemiological data on their risks of long-term disability are scant, undermining comprehensive injury control efforts. This population-based prospective cohort study investigated the functional status and health-related quality of life of seriously injured Australian children over a 5-year period. Methods Patients aged <18 years hospitalised for major trauma (Injury Severity Score >12) in the State of Victoria over a 12-month period were followed-up at 6, 12, 24, 36, 48 and 60-months post-injury. Primary outcomes were assessed using the PedsQL, King’s Outcome Scale for Childhood Head Injury and the Glasgow Outcome Scale-Extended. Multivariable regression models investigated factors associated with outcomes. Results Of the 186 participants, 71% were retained to 60 months post-injury. At five years post-injury, only 39% had fully recovered while 39% experienced moderate to severe disability. Despite gains in functional status across the five years, psychosocial recovery lagged improvements in physical health. Factors associated with adverse outcomes included older age at injury, female sex, socio-economic disadvantage, remote/regional (versus urban) residence, pre-existing comorbidities, and injuries deemed compensable, intentional, or involving head trauma. Implications The high risks of long-term disability following serious childhood injury highlight the need for robust injury control efforts that monitor and address the inequitable burden of childhood injury, including the social determinants influencing the occurrence as well as sequelae following injury.

Unveiling loneliness: health determinants of feeling alone in the older urban residents

Abstract In older people health condition contributes to the feeling of being alone (loneliness). We aimed to assess which chronic health conditions are the strongest determinants of loneliness in older urban residents. Participants of the Polish part of the HAPIEE Study (Health Alcohol and Psychosocial Factors in Eastern Europe) examined in 2019-20 were included to the analysis. Trained nurses interviewed respondents in their homes. Loneliness was assessed using 3-item UCLA scale (range: 3-9, cuf-off≥ 6 points). Socioeconomic data, self-rated health (SRH) and the history of 18 diseases diagnosed by the doctor was assessed using standardized questionnaire. Multivariable logistic regression was used; odds ratios and 95% confidence intervals are presented (OR (95%CI)). There were 461 participants (48% males) of mean age 72 years (SD = 6.3). In 34 participants (7%) UCLA score was 6 or more. The majority (63%) of respondents were married or cohabiting. Nearly 90% declared having children. After adjustment for marital status and having children, poor distance vision 3.84 (1.31-6.12), hearing problems 2.20 (1.07-4.53), acute back pain syndrome 2.21 (1.06-4.59) and cancer 2.36 (1.03-5.41) were determinants of loneliness. Further adjustment for age weakened the association with distance vision 2.74 (1.26-5.94) and waved the relationship with hearing problems 2.06 (0.99-4.29). The estimates for remaining health conditions remained almost unchanged. The strongest predictor of loneliness was SRH. After adjustment for age, marital status, having children and objective burden of chronic diseases, compared to good SRH, participants with moderate and poor SRH were more likely to report loneliness by over 3 and 6 times: 3.41 (1.29-9.05) and 6.60 (2.16-20.18), respectively. The perception of poor health and diagnosis of cancer strongly determined loneliness in older people, but other important predictors of loneliness were conditions that objectively hinder maintaining social contacts. Key messages • In older people health condition is related to the feeling of being alone, and the strongest objective health determinant of loneliness was diagnosis of cancer. • Independently of objective burden of chronic diseases, self-rated health was a significant predictor of loneliness in older urban residents.

Loneliness and the prevalence of injuries, falls and fractures in older people

Abstract The feeling of being alone (loneliness) experienced by older people contributes to deterioration of health, reduced physical and mental fitness, or inability to continue life roles. Loneliness may lead to behaviors that increase the risk of accidents, falls, and fractures, which are particularly dangerous in old age. The aim of this study was to assess the relationship between loneliness and the prevalence of injuries, falls, and fractures in older people. The studied group consisted of 464 people (48% men), aged 62-86 years (mean: 71.6, SD: 6.3), who participated in the Polish part of the HAPIEE Study (Health Alcohol and Psychosocial Factors in Eastern Europe); random subsample examined in 2019-2020. Trained nurses interviewed respondents in their homes. The 3-item UCLA scale (range 3-9, cut-off point≥6) was used to assess loneliness. Data on injuries or accidents in previous 10 years, falls in previous 12 months, history of wrist, hip fracture or undergoing joint surgery/alloplastic was recorded. Multivariable logistic regression analysis was used. There were 460 participants included in the analysis. In 34 participants (7.3%) UCLA score was ≥6. In the previous 10 years, 95 respondents (20.5%) reported an injury or accident, 77 (16.6%) fell in previous 12 months. There were 6 (1.3%) respondents with history of hip fracture, 48 (10.3%) with history of wrist fracture, and 35 (7.5%) with history of joint surgery/alloplastic. No statistically significant relationship between loneliness and the prevalence of injuries, falls and fractures in older residents was found neither in the crude models nor after adjustment for covariates (age, sex, BMI, marital status, having offspring). Loneliness did not predict injuries, falls, and fractures in older urban residents. It seems that perception of being alone is weaker determinant of health as a measure not fully reflecting objective social isolation, which may actually have a greater impact on falls and injuries. Key messages • 1/5 of older people have experienced any injury or accident and 17% reported to have fallen in the previous year. • Loneliness did not predict injuries, falls, and fractures in older urban residents.

Study on the Impact of China’s Pension Insurance System on the Savings Rate of Urban Residents Based on the Preventive Saving Perspective

In the context of population aging, the study of the impact of the pension insurance system on the savings behavior of urban residents can help reduce preventive savings, increase current consumption, and promote the healthy development of the economy. This study constructs a two-period OLG model of the pension insurance system based on the preventive saving perspective using urban panel data of 31 provinces from 2002 to 2021 and conducts empirical analysis through the systematic generalized method of moments. The results show that the pension insurance participation rate was positively correlated with the savings rate, while the pension replacement rate was negatively correlated with the savings rate, and this effect varied significantly across income levels and different levels of aging. Increased participation in high-income areas promoted savings, while increased pension replacement rates in low-income areas reduced savings. The positive correlation between participation rates and savings rates was more pronounced in regions with higher levels of aging, while the opposite was true in regions with lower levels of aging. In addition, the negative correlation between pension replacement ratios and savings rates was particularly pronounced in high-aging regions.

Detection of Brucella militensis in the Serum of Patients Suspected of Brucellosis by the Omp31 Gene Amplification, Compared to the Serological Diagnostic Tests

Background and Objectives: Brucellosis is one of the most common infectious diseases with a global spread. It has a high prevalence in Iran. This study aims to diagnose brucellosis caused by Brucella melitensis in the serum of patients by the amplification of omp31 gene, compared to the serological tests. Methods: Blood samples were collected from 200 people suspected of brucellosis. The samples were evaluated by serological tests including Rose Bengal test, Wright test, Coombs-Wright test, gel agglutination test, and 2-mercaptoethanol (2ME) test. DNA extraction was done by the phenol/chloroform extraction method. Molecular detection with polymerase chain reaction (PCR) method was done using the specific primers of the Omp31 gene. Data were analyzed in SPSS software, version 23 using the analysis of variance. Results: Of 200 patients, 122 were female and 78 were male with a mean age of 45.17±17.43 years. The results of PCR test for the omp31 gene were positive in 14.5% of cases, which was consistent with the results of serological tests (13.8%). The sensitivity of Wright, Coombs-Wright, 2ME, and gel agglutination tests, compared to PCR, was 89.7, 75.9, 55.2 and 55.2%, respectively. Most of the affected people were housekeepers (41.5%) and urban residents (75.5%). Muscle pain (68%) and leg pain (62.3%) were the most common symptoms. Consumption of non-pasteurized dairy products was the highest risk factor (17%). Conclusion: The diagnosis of brucellosis by the omp31 gene amplification has higher sensitivity and accuracy compared to the serological tests. Considering the importance of rapid and timely diagnosis of brucellosis to control its clinical complications, the molecular diagnosis method is recommended as a diagnostic method.

Evaluating the Improvement of Healthcare Accessibility for Urban Residents via the Construction of New Hospitals: A Case Study of Xi’an, China

Evaluating the Improvement of Healthcare Accessibility for Urban Residents via the Construction of New Hospitals: A Case Study of Xi’an, China

A study on the impact of high-speed rail on the consumption structure of urban and rural residents in China.

Consumption is crucial to individual well-being and national economic development. This study investigates whether high-speed rail (HSR) influences consumption expenditure (CE) and consumption structure (CS) of urban and rural Chinese citizens. Using panel data from 2003 to 2019 and econometric models, this study finds that: (1) HSR significantly increases CE for both urban and rural residents, promotes CS upgrades in rural areas, but inhibits CS upgrades in urban areas. These results remain robust after extensive testing. (2) HSR's impact on urban consumption is relatively focused and singular, whereas its effect on rural consumption is dispersed and extensive. Additionally, the impact of HSR on consumption exhibited significant delays and regional characteristics. (3) Mediation analysis reveals that HSR significantly enhances urban and rural CE and facilitates rural CS upgrades through market, price, and income effects. However, it also triggers housing price increases, impeding urban CS upgrades. This study provides important references for the government to optimize transportation infrastructure investments, promote balanced economic development between urban and rural areas, and enhance residents' well-being.

The influence of physical exercise on adolescents' externalizing problem behaviors: mediating effects of parent-child relationships, self-esteem, and self-control.

Externalizing problem behaviors can significantly and negatively impact adolescents' learning, daily life, and future socialization. While physical exercise is believed to inhibit adolescents' externalizing problem behaviors, the extent of its effect and the mediating mechanisms remain unclear. This study is based on data from the 2018 China Family Panel Studies (CFPS). The CFPS project employed the Externalizing Problem Behaviors Scale (EPBS), the Rosenberg Self-Esteem Scale (RSES), and the Self-Control Scale (SCS) to measure adolescents' externalizing problem behaviors, self-esteem, and self-control. Additionally, physical exercise was measured by collecting data on the time and frequency of adolescents' physical exercise. Parent-child relationships were evaluated using a composite variable that included four dimensions: frequency of quarrels, frequency of heart-to-heart talks, parental awareness of their children's whereabouts, and children's trust in their parents. Based on data collection and variable construction, this study employed multiple linear regression, propensity score matching, and quantile regression to analyze the impact of physical exercise on adolescents' externalizing problem behaviors and the heterogeneity of these effects. Additionally, the Bootstrap mediation effect test was employed to explore the mediating roles of parent-child relationships, self-esteem, and self-control in this process. The analysis demonstrates that physical exercise significantly inhibits adolescents' externalizing problem behaviors (β = -0.095, p < 0.01), although the effect varies significantly among different populations. Compared to males (β = -0.077, p < 0.1), rural residents (β = -0.065, p > 0.1), individuals with poorer family economic status (β = -0.080, p < 0.1), and those with more severe problem behaviors (τ = 0.75, β = -0.086, p < 0.05), physical exercise yields a more pronounced inhibitory effect on females (β = -0.113, p < 0.01), urban residents (β = -0.134, p < 0.01), individuals with better family economic status (β = -0.115, p < 0.01), and those with milder problem behaviors (τ = 0.25, β = -0.112, p < 0.01). Furthermore, through enhancements in parent-child relationships (CI: -0.015; -0.002), self-esteem (CI: -0.019; -0.003), and self-control (CI: -0.055; -0.025), physical exercise indirectly mitigates adolescents' externalizing problem behaviors. Physical exercise significantly reduces adolescents' externalizing problem behaviors, with effects differing across various groups. Parent-child relationships, self-esteem, and self-control mediate this relationship, underscoring the positive influence of exercise on adolescent behavior.

Research Progress in the Design Concept of Green Commuting Cities

Abstract: The connection between green commuting and urban design was intimately intertwined in this study. As urbanization progressed, issues such as population growth, housing, transportation, and the environment had become increasingly salient. Green commuting had emerged as a vital strategy to mitigate these challenges and enhance the quality of life for urban residents. This paper elucidated the principles underlying green commuting, highlighting a human-centric approach, the interconnections between public transit, walking, and cycling as modes of travel, and the significance of the digital city paradigm. By examining the transportation systems and urban design methodologies, techniques, and characteristics of Vienna and Copenhagen, the paper delineated the strengths and weaknesses in the development of these cities. It delved into the design approaches and philosophies in green commuting from these two cities that were exemplary and worthy of emulation. The paper proposed potential strategies for green and low-carbon design in future urban transportation, aiming to construct a more ecologically sustainable urban transportation system and infuse new dynamism into urban development.

The Impact of Virtual Immersive Public Art on the Restorative Experience of Urban Residents

This study explores the role of virtual immersive public art in improving the psychological well-being of urban residents. The research is set in the context of urban environments, where virtual immersive public art has the potential to foster innovation, integrate technology, and organically blend into public spaces. The study evaluates the impact of such art on psychological restoration by focusing on three key dimensions: interactive themes, interactive mechanisms, and artistic characteristics. A questionnaire survey was conducted to collect participants’ real-life experiences and reactions to these art installations. The results show that virtual immersive public art significantly contributes to the restorative experience of urban residents, offering valuable insights into how these installations can promote mental health. Based on the findings, the study provides practical design recommendations for incorporating virtual immersive public art into future urban planning and design projects to enhance urban living conditions and support psychological recovery.

Attitudes towards air quality during outdoor exercise amongst habitual exercisers.

The effects of air pollution on health outcomes are well-established. However, little is known about perceptions of air pollution and how it may influence exercise behaviours. The aim of this study was to understand the perceived importance of air pollution during planned exercise, and where relevant, explore how those perceptions may differ between those living in different locations. A questionnaire was disseminated to several running and cycling clubs in the United Kingdom, covering population characteristics to determine urban, rural or coastal residents and exercisers, self-reported asthma, perceptions of air quality during active travel, planned exercise and attitudes towards learning more about the topic. Anonymised responses were gained from 381 adult participants (≥18years and 60% female), 119 of whom answered questions related to active travel. More than half (54%) of all respondents think about the air quality they are exposed to during exercise and how it may affect their health. More urban than rural respondents (59% vs. 47% and p=0.03) think about air quality and the impact it may have on their health when exercising. There were insufficient coastal respondents for direct comparison. Most survey respondents (57%) state that they would take the most severe course of action regarding exercise behaviour by avoiding it altogether during periods ofheavy road traffic. Individuals with self-reported asthma (n=60), irrespective of place of residence, are the most likely to be conscious of the potential effects of air pollution on their health and exercise performance compared to counterparts without self-reported asthma.

Prevalence and Determinants of Ideal Cardiovascular Health in Kenya: A Cross-Sectional Study Using Data From the 2015 Kenya STEPwise Survey.

Kenya is experiencing a rising burden of cardiovascular diseases (CVDs) due to epidemiological and demographic shifts, along with increasing risk factors. Ideal cardiovascular health (iCVH), defined by the American Heart Association (AHA), encompasses eight metrics to evaluate cardiovascular well-being. This study assessed the prevalence and determinants of iCVH in Kenya. Data from the 2015 Kenya STEPwise survey on non-communicable disease risk factors, including 4,500 adults aged 18-69, were analysed. iCVH was assessed using 2022 AHA criteria based on seven factors: nicotine exposure, physical activity, diet, BMI, blood pressure, glucose, and lipid levels. A cardiovascular health (CVH) CVH score of ≥80% classified individuals as having iCVH. Multivariable binary and ordinal logistic regression identified factors associated with iCVH. The mean CVH score in Kenya was 78.6% (95% CI: 77.9,79.2%), higher in females (79.3%), rural areas (79.5%), and non-drinkers (79.6%) than in males (77.9%), urban residents (77.0%), and alcohol drinkers (75.4%), respectively. The prevalence of iCVH (CVH score ≥80%) was 45.6%, while 6.4% had poor CVH (CVH score <50%). Only 1.2% achieved the maximum CVH score. iCVH prevalence declined with age and was lower among married individuals (43.7%), alcohol drinkers (32.3%), and urban residents (39.7%). Older adults had 50-80% lower odds of iCVH compared to those under 30 years. Alcohol users (AOR 0.5; p < 0.001) and urban residents (AOR 0.6; p < 0.001) were less likely to have iCVH. Residents of Nairobi and Central regions had 40-60% lower odds of iCVH compared to those in Rift Valley. The Kalenjin (AOR 0.5; p = 0.027) and Turkana (AOR 0.3; p = 0.002) ethnic groups had lower odds of iCVH compared to the Kisii. Less than half of Kenyan adults have iCVH, with poorer CVH status among older adults, urban residents, and alcohol users. Targeted public health interventions could mitigate the CVD burden and enhance health outcomes in Kenya.

A Demographic Description of Children and Adolescents With Concomitant Autism and Anxiety Along With a Comparison of Receipt of Psychological Services

Objective: (1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism. Methods: Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann–Whitney U tests, χ2 tests of association, and logistic regression. Results: Demographic differences between children/adolescents with autism alone versus autism concomitant with anxiety were noted for age, sex, and race/ethnicity, with a greater prevalence of autism/anxiety identified in older-aged children and children identifying as female and non-Hispanic White residing in an urban area. While 21% of those included in this study had received psychotherapy, the percentages within the autism only and autism/anxiety groups were 12% and 50%, respectively (p &lt; 0.001). Children/adolescents who were older age quartile, resided in an urban residence, and with a concomitant diagnosis of anxiety were more likely to receive psychological services, while non-Hispanic Other were less likely to, compared with the reference of non-Hispanic White. Conclusion: We identified demographic disparities in the diagnosis of autism versus autism with concomitant anxiety, including age, sex, race/ethnicity, and residence location. Age quartile, urban location, and concomitant anxiety were associated with increased likelihood of receipt of psychological services.

Prevalence of Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus on Metformin Therapy: A Cross-Sectional Study.

Background Metformin is frequently prescribed as a first-line oral hypoglycemic drug to treat insulin resistance-causing type 2 diabetesmellitus (T2DM). Long-term metformin use results in vitamin B12 deficiency, which is frequently overlooked and undiagnosed. A severe deficit may cause severe anemiaand gastrointestinal, or neurological issues. Studies are scarce onthis issue in Pakistani patients with T2DM. The current study aimed to estimate the prevalence of metformin-induced vitamin B12 deficiency in T2DM patients and to explore how it relates to metformin dosage or duration of therapy. Methodology A descriptive cross-sectional study was conducted on 260 T2DM patients using metformin therapy for more than a year and attending the outpatient diabetes clinic and the medicine department of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan, from August 2022 to October 2023. All socio-demographic, clinical, and general characteristics were collected. Blood samples were taken to measure the serum vitamin B12 levels, and based on these levels, deficient and normal group characteristics were compared. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results Based on the serum levels of vitamin B12 of the studied T2DM on the metformin regimen, the overall prevalence of vitamin B12 deficiency was found to be 36.54% (95). The B12 deficiency was higher among the age group of 41-50 years (109, 41.9%), female gender (150, 57.7%, p-value=0.0035), urban residents (194, 74.6%), non-smokers (197, 75.8%), and with a history of chronic disease (131, 50.4%). There was a statistically significant difference in vitamin B12 levels based on T2DM duration (p=0.012), with a higher prevalence in patients with a longer diabetes history of more than two years. There was no discernible statistical relationship between patients receiving different dosages of metformin (odds ratio (OR)=0.8627; 95% confidence interval (CI) (0.5195, 1.4326); p-value=0.568), durations of metformin (OR=0.7400; 95% CI (0.442, 1.2325); p-value=0.247), or intake of vitamin B12 (OR=0.8532; 95% CI (0.5073, 1.4351); p-value=0.549). Conclusion The prevalence of vitamin B12 deficiency impacted more than one-third of T2DM patients using metformin (36.54%). The risk of vitamin B12 deficiency may increase in females with higher metformin dosages and longer durations of treatment. Furthermore, a statistically significant correlation exists between vitamin B12 deficiency and the longer duration of T2DM. These findings highlight the relevance of routinely monitoring serum levels of vitamin B12 among those with T2DM, especially when metformin is being given for over a year or at doses greater than 1000 mg per day. These preventive strategies will aid in the early detection of vitamin B12 deficiency, allowing patients to be treated with supplementation before problems such as anemia or neuropathies arise, resulting in improved quality of life and a lower socioeconomic burden.

Resuming work roles after injury in a low-income context: Multiple factors influencing the return to work outcomes.

Return to work (RTW) is an important outcome indicator for the effectiveness of rehabilitation services, and the functional status and overall recovery among individuals who have experienced injury. Despite the rising incidence of traumatic injury among economically productive citizens in Ethiopia, there is a paucity of evidence about the RTW status of injury survivors. This study examined factors associated with RTW success and determinants of time to RTW after injury in Ethiopia. An institution-based cross-sectional study was conducted to collect data retrospectively one year after patients arrived at the study setting due to traumatic injuries. Medical records of all patients who visited the emergency room of a large public hospital in Addis Ababa were reviewed. Data were collected from survivors of traumatic injury, interviewed by telephone one year post-injury. Multivariable logistic regression and survival analysis were carried out to explore factors. Of the 251 participants, 75% were young adults (age </ = 39 years), 78% were male, 78% were urban residents, 41% were injured by road traffic collisions, and 59% returned to work within one year. The logistic regression model revealed short inpatient admission (AOR = 4.20; 95% CI: 2.10-8.50; p ≤ 0.001), no disability (AOR = 4.44; 95% CI: 2.10-9.60; p ≤ 0.001), motivation to RTW (AOR = 3.50; 95% CI: 1.61-7.50; p = 0.002), no chronic illness (AOR = 2.31; 95% CI: 1.14-4.70; p = 0.020), being in an administrative position (AOR = 5.32; 95% CI: 1.11-25.78; p = 0.038) and receiving injury compensation (AOR = 3.10; 95% CI: 1.22-7.73; p = 0.017) as factors for successful RTW within a year after injury. Further, the Cox regression analysis identified immediate access to healthcare after injury (AHR = 1.54; 95% CI: 1.05-2.25; p ≤ 0.026) and having injury of penetrative to internal organ, strain, sprain, dislocation or soft tissue (AHR = 1.81; 95% CI: 1.20-2.80; p = 0.007) as determinants of early RTW after traumatic injury. The study uncovers factors crucial to RTW planning and interventions, and provides insights to minimize barriers, foster a smooth transition to employment, and optimize survivors' lives after injury.

38 Disparities in health outcomes by the age of five among preterm children in rural versus urban communities in British Columbia

Abstract Background Health disparities exist between than urban and rural communities, as rates of preterm birth, severe maternal morbidity and severe neonatal morbidity are higher in rural areas. There are limited population-based studies on early childhood health outcomes among those born preterm by geographical area. Objectives To compare health service use, morbidity, and medication use for up to five years of age between preterm children in rural versus urban residences. Design/Methods The study included liveborn infants at 22-44 weeks’ gestational age (GA) in British Columbia (BC), Canada, 2004-2014. Follow-up data to December 2019 included linked health information from four provincial databases (perinatal database, outpatient visits, hospitalizations, and outpatient prescriptions). Urban-rural status was based on maternal residence at birth. Rate ratios (RR) of health service use, childhood morbidity and medication use were compared within GA categories (22-27, 28-33, 34-36, 37-44) by rural vs. urban region using Poisson regression. Results There were 49,555 (10.9%) rural and 406,149 (89.1%) urban children included in this study. 42,789 children were born at &amp;lt;37 weeks GA, and the preterm birth rate was 9.4%. Compared to urban areas, children in rural regions had more hospitalizations (28-33 weeks: RR 1.35, 95% CI: 1.19-1.51; 34-36 weeks: RR 1.35, 95% CI 1.27-1.44; 37-44 weeks: RR 1.32, 95% CI 1.29-1.34) by five years of age; and significantly fewer outpatient visits (22-27 weeks: RR 0.90, 95% CI: 0.87-0.93; 28-33 weeks: RR 0.81, 95% CI: 0.80-0.82; 34-36 weeks: RR 0.75, 95% CI 0.74-0.75; 37-44 weeks: RR 0.71, 95% CI 0.71-0.71). Rural children born at 34-36 weeks had significantly higher rates of bronchiolitis (RR: 1.35, 95% CI: 1.16-1.56) compared to urban children. They were prescribed more antibiotics and bronchodilators (RR: 1.15, 95% CI: 1.13-1.17, and RR: 1.12, 95% CI: 1.05-1.19, respectively). Conclusion Compared with urban areas, preterm children living in rural regions of BC had higher rates of hospitalization, higher rates of bronchiolitis and more frequent prescriptions of antibiotics and bronchodilators by five years of age. These disparities in health status and service use warrant further research and public health interventions.